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Organization
REACHING OUT MINISTRIES
Active
Organization
REACHING OUT MINISTRIES
Active
Other names
Paradise Smiles Dental Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNY WAYNE BOURGEOIS DDS (PRESIDENT/PRIMARY DENTAL PROVIDER)
(671) 646-2010
Entity
Organization
Contact information
Practice address
226 CHALAN SAN ANTONIO STE C, AMPARO'S BUSINESS CENTER, TAMUNING, GU 96913-3525
(671) 646-2010
(671) 646-2070
Mailing address
226 CHALAN SAN ANTONIO STE C, AMPARO'S BUSINESS CENTER, TAMUNING, GU 96913-3525
(671) 646-2010
(671) 646-2070
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
14605
TX
261QD0000X
Dental Clinic/Center
Primary
D927
GU
Other
Enumeration date
07/22/2009
Last updated
07/22/2009
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